Marriage Certificate - Glaser, Teresa M_4/4/2001��c��s �pLi— C� 1513 �
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STATE OF INDIANA
APF'LIGAI IUN hGN M
GIBSON
!C35-7-4-1. Furnl�hlnqlalsoinformallonuoonepO�Y��9�orlicenae.
A De�son wh0 knowing�y fumishes lalse intorma6on io a clerk ol the
tircuil coutl when Ihe per;on ap0��es br a marriage license under IC
37-i -3 commils a Class D Ieiony.
MALE APFLICANT � rf��
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Mo��er ID •
$upuripeE �M t�Om to 0[lon m� Inls — ary al 19_
CInY.
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No.
AMHIACit LII:tNSt File
COUNTY oa;aot oo���.uo�
Female Aoplicant 50> No ❑ Yes ❑
It No, Pdetlical Ezami�acio�o �r Oated
t Name ol Fhysician �_� i�
FEMALE A7PLICRNT
wie o� 9inn
PrMau Marila15Uluf' NsrV Marnep C�/OR No. ol
�ear
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9innpl�c� el lal�p (Sl�te or Iwei�n [aunthl
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W aaopin. iu� eaoo��•e vvmu onry� C[ t
NeiiCM[�e1m0111e�1il0�cMf�E.fofitle) _
BlMqau ol mol�er (Sl��e or lo�viqn mun�ry)
♦LSNOWIEDGME4T
I e[amxlMa� 1�.>I I IvA rKfireC inlINna�1�MleqMOUp O�nO[rw] COTmuniidf CiHUef
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Sumcr���y � �m�mi� a�rol_� �5
�L i Cbrt ol Ne GlCSOn Clrcui� Cqm
GONSENT Oi p1PEM5, F1HENi, OR GU�HOI/.N
N'1. N� p�n^I] al Nif 10U��Gn1, ��flDy piv<cenNnt lal llllf m��ry�e.11 oNy O1e G�enl fiqnf.
s.a:ebCbwEKXnlieN�CamenlalNeaNerpLeatu[oetnary _.
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COYn�Y cl �
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Mol�er 10 •
SuOec�ipt0 an0 SwOm �o O�lore me I�if — Eay ol 19—
Giv�
COMVLETE IF MARRIAGE LICENSE ISSUE� BY ONDER OF COURT. A marriage licanse having been relusea to l�e above nameE parties. t�a
County Court. Oy wriiten order issuetl
an0 tileC in aui�orizes an0 tlirects t�e issuance o/ a marrieqe license Io the above name0 parties.
RETURN OF MARRIAGF. WCENSE A,�'D MARRIACE CERTIFICATE
I cer[ifyc.�Iha,f, �Ih�u�e wns filed in, /my office a marriage'lirense is%,a�ued 6y the Cler o( [he Circuit Court of Gi6son County, Indiene,
dnted "'� ��CJ�-.� � 94 r authorizing the marnage of `�n� ��' °��� und
�.�.a a.. �rn.'�a�,Q,
f �rurjh�er� cer 'fy Ihat the folluwing mnrriage certificate was (iled in my oK y�� /J �.�
/� �4'U. lLO� ame), c ti v hal on / 9 (date)�jt!�✓a�= ��"�-� — in
County; ❑dia . of �ei`� CountY.
_-�,��� (s(ete), and � of C �J CaunfY.
(afate) a�ere menied by me es thoriz under e marriage license fba[ was issued by the Clerk of Ihe
Cimuit Cou�rt/9 fC�ibs � CvunU; I d�i� m��, dated " ' '
g(F�� ��.; iCI'/�� �itA/K__ ±(�N � ��.A1�{Y/tA.0.a4' (officisl des'ig/net3im)
Filyd and retorded in accordance with Lhe lews ot the Ste[e ot ludiana m T�'^ ��(de[e).
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